Optimizing cost-effectiveness in perioperative care for liver transplantation: A model for low- to medium-income countries
✍ Scribed by Karina Rando; Claus U. Niemann; Pilar Taura; John Klinck
- Publisher
- John Wiley and Sons
- Year
- 2011
- Tongue
- English
- Weight
- 277 KB
- Volume
- 17
- Category
- Article
- ISSN
- 1527-6465
- DOI
- 10.1002/lt.22405
No coin nor oath required. For personal study only.
✦ Synopsis
Although liver transplantation (LT) is a highly effective treatment, it has been considered too costly for publicly funded health systems in many countries with low to medium average incomes. However, with economic growth and improving results, some governments are reconsidering this position. Cost-effectiveness data for LT are limited, especially in perioperative care, and the techniques and costs vary widely between centers without overt differences in outcomes. Anesthesiologists working in new programs find it difficult to determine which modalities are essential, which are needed only in exceptional circumstances, and which may be omitted without effects on outcomes. We investigated key elements of preoperative evaluations, intraoperative management, and early postoperative care that might significantly affect costs in order to develop a best-value approach for new programs in resource-limited health systems. We identified all modalities of care commonly used in anesthesia and perioperative care for adult LT along with their costs. Those considered to be universally accepted as minimum requirements for safe care were excluded from the analysis, and so were those considered to be safe and lowcost, even when evidence of efficacy was lacking. The remaining items were, therefore, those with uncertain or context-restricted value and significant costs. A systematic review of the published evidence, practice surveys, and institutional guidelines was performed, and the evidence was graded and summarized. With respect to costs and benefits, each modality was then cited as strongly recommended, recommended or optional, or no recommendation was made because of insufficient